Atopic or allergic dermatitis is a common condition that shows up as dry skin and inflamed rashes.
A woman's history of allergy affects the odds of her child developing it within six months of birth.
From age six to 12 months, the odds are further raised if the child attends a daycare centre and his mother also has a history of allergy.
If the condition sets in after the child turns one - in what is known as late-onset atopic dermatitis - it is linked to two other factors.
One, the child may have been given probiotics when he was between nine and 12 months.
Two, he could have been given antibiotics between his birth and sixth month.
These local research findings were published online in April last year in the International Archives Of Allergy And Immunology.
There search is part of an ongoing project called Growing Up in Singapore Towards Healthy Outcomes, which was started in 2009 with about 1,200 expectant women.
It is a collaboration between the National University Health System, KK Women's and Children's Hospital and A*Star's Singapore Institute for Clinical Sciences.
Atopic dermatitis has been highlighted as a likely first step in the "atopic march", which is the progression of allergic disorders from early childhood onwards.
Dr Lynn Chiam, a dermatologist at Mount Elizabeth Novena Specialist Medical Centre, said: "In the atopic march, young patients develop atopic eczema early on, followed by a typical sequence of allergic rhinitis and asthma.
"One allergy may subside as another starts, or the allergies may overlap so that they suffer from more than one at a time. Some may persist for years, whereas others may resolve with age."
The researchers note that, because of this march, the predisposing factors for atopic dermatitis must be identified.
Professor Lee Bee Wah, one of the study's authors, said atopic dermatitis is likely to be caused by a combination of an abnormal skin barrier - often manifested as dry skin - and a propensity for the skin to get inflamed.
Those with an earlier onset of atopic dermatitis seem to be at a higher risk of developing environmental allergies, she added.
Dr Chiam, who was not involved in the study, postulated that the higher odds of getting atopic dermatitis after attending a daycare centre may be linked to the child's exposure to viruses, pollution and an altered skin hygiene.
But Prof Lee, from the department of paediatrics at the National University of Singapore's Yong Loo Lin School of Medicine, pointed out that the risk from probiotics may be confounded by the tendency of mothers to use it on their children who are already at risk of atopic dermatitis, hence giving the false impression that probiotics increases the risk of atopic dermatitis.
As for antibiotics, animal studies suggest that they alter the "good" bacteria in our body and reduce our defence against inflammatory conditions.
Antibiotics are prescribed to treat bacterial infections but viral infections are, by far, more common in children, she said.
She emphasised that the factors mentioned, including maternal history, probiotics and antibiotics, may not be direct causes of atopic dermatitis but may raise the risk of a child developing the condition.
Here are tips from Prof Lee and Dr Chiam on caring for children with atopic dermatitis:
MOISTURISE SKIN WELL
Choose a moisturiser that suits the child's skin. It should not make the skin red and should not sting .
Commercial moisturisers aim to replace the natural moisturisers that our skin produce. Choose one that contains products of filaggrin - a protein that helps to keep skin condition healthy - such as arginine, sodium pyrrolidone carboxylic acid and ceramides, to rebuild the child's natural skin barrier.
A good example is the Cetaphil Restoraderm moisturiser. An ideal body wash should also contain these filaggrin products.
DO NOT IRRITATE SKIN
Avoid excessive heat, use of harsh soaps and applications such as liniments and powders, which dry the skin. Instead, use bath oils or non- soap cleansers. After a shower, dab the skin dry instead of rubbing it .
For those whose skin condition is made worse with heat and sweat, it is important to stay in a cool environment. Avoid excessive exposure to sunlight and the use of thick woollen clothes which may further irritate the skin.
BEWARE OF INFECTED ECZEMA
Broken and oozing skin is often a sign of infected eczema. Keep fingernails short and remind children not to scratch, which will worsen the rash. Apply cold packs to reduce the itch. Atopic dermatitis is particularly prone to bacterial infection. When infection occurs, eczema often flares and it may need medical treatment.
KNOW AGGRAVATING FACTORS
Illnesses, fevers, stress, insufficient sleep and tiredness can aggravate eczema. Some of these cannot be avoided but, in these situations, skin care may have to be intensified.
This article was first published on April 26, 2016.
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